Yes, Americans die earlier without health insurance, health experts say

WASHINGTON – Do people die because they lack health insurance?

Rep. Raul Labrador, R-Idaho, found himself in a pickle — and in monologue by late night talk-show host Jimmy Kimmel — when he suggested they don't. He later elaborated that he was making the point that no one would "die in the streets" under the Republican health care plan, because hospitals are required by law to treat any patient in need of emergency care.

But health care advocates say his explanation falls short of reality, pointing to a host of studies that show access to health care does prevent premature death, in the case of Americans with conditions such as cancer, diabetes, coronary heart disease, respiratory failure and asthma.

While researchers may quibble over the exact figures, they say the evidence is plain: Americans do die earlier because they don't have access to health insurance. Those studies include a 2012 survey that found lower mortality rates among states that expanded their Medicaid programs compared with states that did not.

"No one says the number is zero," said Rachel Garfield, a senior researcher for the Kaiser Family Foundation. "There may be some disagreement on the scale, but there is a lot of agreement that there are health effects."

U.S. law does require that hospitals treat emergency room patients until they are stable, "but they don't have to provide ongoing treatment for a chronic condition," Garfield said. That means the emergency room may stop the bleeding, but that people without health insurance may have challenges controlling diabetes or high blood pressure.

The Institute of Medicine — now part of the National Academies of Sciences, Engineering, and Medicine — was among the first to put a number find a link with a 2002 report, "Care Without Coverage: Too Little, Too Late," which found a 25 percent higher mortality risk for the uninsured based on an analysis of scientific studies. The researchers estimated 18,000 people between ages 25 and 64 died in 2000 because they did not have health insurance.

Advocates for President Barack Obama's Affordable Care Act seized on the studies in the run up to the debate over the legislation, particularly a study published in the American Journal of Public Health in 2009 that found nearly 45,000 deaths a year linked to a lack of health insurance.

That study, conducted at Harvard Medical School and Cambridge Health Alliance, found that uninsured Americans had a 40 percent higher risk of death than those with insurance. Some critics noted that two of the researchers co-founded Physicians for a National Health Program, which supports a single-payer health system.

And some pointed to a 2009 study by a former Clinton and Obama administration official that questioned the initial estimate of 18,000 deaths, saying there was "little evidence to suggest that extending insurance coverage to all adults would have a large effect on the number of deaths in the United States."

The author of that report says more recent studies further support the "commonsense notion" that access to health insurance saves lives.

"The accumulated weight of evidence at this point makes it pretty clear that health insurance results in lower morbidity and lower mortality," said Richard Kronick, a former director of the Health and Human Services' Agency for Healthcare Research and Quality. "There's still uncertainty about exactly how much, but I don't think there's any doubt that there's an effect there and an important effect. To say that there's no relationship is really either ignoring or misreading the available evidence."